title: Amputations and foot-related hospitalisations disproportionately affect dialysis patients.
abstract: Patients with diabetes have increased risk for foot ulcers, amputations and hospitalisations. We evaluated a closed cohort of patients with diabetes and established risk factors in two high risk groups: (i) dialysis patients and (ii) patients with previous foot ulceration. We used claims data for diabetes (ICD-9 250.X), ulceration (ICD-9 707·10, 707·14 and 707·15) and dialysis (CPT 90935-90937) from the Scott and White Health Plan to identify 150 consecutive patients with diabetes on dialysis (dialysis group) and 150 patients with a history of foot ulceration (ulcer history group). We verified these diagnoses by manually reviewing corresponding electronic medical records. Each patient was provided 30 months follow-up period. The incidence of foot ulcers was the same in dialysis patients and patients with an ulcer history (210 per 1000 person-years). The amputation incidence rate was higher in dialysis patients (58·0 versus 13·3, P < 0·001). Hospital admission was common in both study groups. The incidence of hospitalisation was higher in the ulcer history group (477·3 versus 381·3, P < 0·001); however, there were more foot-related hospital admissions in the dialysis group (32·9% versus 14·0%, P < 0·001) during the 30-month evaluation period. The incidence of ulcers, amputations and all-cause hospitalisations is high in persons with diabetes and a history of foot ulceration or on dialysis treatment; however, those on dialysis treatment have disproportionately higher rates of foot-related hospitalisations. Intervention strategies to reduce the burden of diabetic foot disease must target dialysis patients as a high-risk group.
authors.affiliation: Department of Plastic Surgery, University of Texas Southwestern Medical Center, Parkland Hospital, Dallas, TX, USA.
authors.forename: Lawrence A
authors.initials: LA
authors.lastname: Lavery
authors.affiliation: Statistical Consulting, Aurora, CO, USA.
authors.forename: David C
authors.initials: DC
authors.lastname: Lavery
authors.affiliation: Orthopaedic and Spine Center of the Rockies, Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, USA.
authors.forename: Nathan A
authors.initials: NA
authors.lastname: Hunt
authors.affiliation: Department of Plastic Surgery, University of Texas Southwestern Medical Center, Parkland Hospital, Dallas, TX, USA.
authors.forename: Javier
authors.initials: J
authors.lastname: La Fontaine
authors.affiliation: Manchester Diabetes Centre, Manchester Academic Health Science Centre, Manchester NIHR Biomedical Research Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.|Cardiovascular Research group, School of Laboratory and Clinical Sciences, University of Manchester, Manchester, UK.
authors.forename: Agbor
authors.initials: A
authors.lastname: Ndip
authors.affiliation: Manchester Diabetes Centre, Manchester Academic Health Science Centre, Manchester NIHR Biomedical Research Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Boulton
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000706:statistics & numerical data*; D016022:Case-Control Studies; D017719:Diabetic Foot / Q000453:epidemiology*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D006435:Renal Dialysis; D051437:Renal Insufficiency / Q000150:complications* / Q000628:therapy; D012307:Risk Factors
keywords: Amputation; Diabetes; Dialysis; Epidemiology; Ulcer